Government Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

14566GA Issued in GA

Legal business name

GOVERNMENT DENTAL LLC

Doing business as

Elite Dental Group

Practice address

7218 Highway 85
Riverdale, GA 30274-2908

Phone

(404) 593-3404

Fax

(404) 228-9673

NPI assigned

Apr 6, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Francine Weatherspoon Dixon

Title

Ceo

Phone

(865) 256-2638

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elite Dental Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fredrico Albert Dixon III, DDS

  • General Practice Dentistry
  • Riverdale, GA
  • NPI 1396820775
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590192000000",
    "number": "1528422524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7218 HIGHWAY 85",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742908",
            "telephone_number": "404-593-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7218 HIGHWAY 85",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742908",
            "telephone_number": "404-593-3404",
            "fax_number": "404-228-9673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOVERNMENT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2020-05-23",
        "certification_date": "2020-05-23",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "FRANCINE",
        "authorized_official_middle_name": "WEATHERSPOON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "865-256-2638",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "14566GA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003180284A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.